Thursday, October 30, 2008

Nursing Talk

I got a really good comment a couple days ago about nursing jargon and abbreviations, and it made me really think and smile and remember back to just a few months ago when I was learning how to "talk like a nurse" and to save my fingers when typing or writing, and since I'm a bad speller, how to save some face and just abbreviate! So I'll make a little list to maybe make reading my ramblings easier. I'm sure I'll forget something, but hopefully it will help a little!

Primip/prime - woman who this is her delivery, it is frequently her first pregnancy too. These labors usually take a little bit longer because the woman's body has never done this before. These women usually come in and have lots of questions and are really nervous, as I would be too! I like prime's because I get to really ease their worries and concerns and help them through the labor.

Multip - women who have had a baby before. Their labors are "usually" faster because their bodies have done this before. Their cervix has already stretched out once, and it just has to "remember" how to do it. They may dilate early in pregnancy and come into the hospital for delivery after walking around 2-4cm for weeks on end. They sometimes seem to get "stuck" about 4-6cm and then all of a sudden go to 10cm in about 30 minutes. As a nurse we watch them for clues that they have "made their move" and are ready to deliver. These women usually come in with fewer initial questions and depending on how their previous labors/deliveries went may be more or less nervous. Women who have only had a c-section are also considered multip's but if they had a scheduled c-section on their first baby (for breech or some other reason) and this is their first vaginal delivery, they may labor like a primip because their cervix has never dilated.

C/S - c-section. Surgical procedure to remove baby from uterus instead of pushing it out through the cervix and vagina. Women have c/s for many reasons. All the doctors I know of will do a c/s if the baby is breech. Many doctors will suggest a c/s if they think the baby may be too big to fit through the mom's pelvis. If a women attempts to deliver vaginally and she "stalls out" she will probably get a c/s, if baby goes into distress then it can be a "throw stuff around the room and get the baby out as soon as possible" c/s. Some women may choose to have a c/s simply because it takes less time and they get to pick their baby's birthday! As far as recovery, it's just like recovering from abdominal surgery ('cuz that's what it is). They haven't figured out how to get a full term baby out lapriscopically, so it's a nice straight line incision right along the bikini line. Most doctors sew up the uterus and muscle tissue, and then use staples on the skin. No sit-ups for 6-8 weeks afterwards!

AROM - artificial rupture of membranes. This is when a doctor/midwife, someone other than the baby in natural labor, breaks the bag of water surrounding the baby. This is usually one of the first steps of an induction (along with the pitocin). After the doctor breaks the water, at least at our hospital, the mom is an inpatient and not going home pregnant. Lots of women worry that breaking the water will hurt. It doesn't "hurt" any more than a regular exam. There are no nerve endings in the bag of water, so it's simply a cervical exam, with maybe a little more pressure and it may take a couple extra seconds. The cervix must be dilated enough for the doctor to at least get a finger inside of it and reach the bag of water. Usually doctors will use an "amnihook" which looks like a plastic crochet hook to simply poke a whole in the membranes. If the woman is barely dilated, they may use an "amnicot" which is like a condom that fits over one finger and has a small little point on the end to break the bag. After AROM (or after the water's broken period) women usually notice that the contractions feel "different." All the fluid that was in front of the baby's head is gone and there's not cushion between the baby's head and the cervix. Without the bag of water in the way, the baby's head is sitting right on top of the cervix and can't float back up with each contraction, and really pushes against the cervix and helps it dilate. Most women really notice that after your water breaks, with every contraction you leak a little (or a lot) of warm amniotic fluid. Some women think this feels gross, others just think it feels weird. Usually the fluid leaks for a while, then baby's head tends to act like a cork and hold it in, then as baby is delivered, all the amniotic fluid that was behind baby comes out and either makes a mess on the floor or sprays on the doctors/nurses/scrubtechs/dads who don't duck just right :)

SROM - spontaneous rupture of membranes. Same as AROM except it happens on it's own. It can happen anywhere (in bed in the middle of the night, when mom goes to the bathroom, in the WalMart parking lot...). Sometimes it's a big gush, sometimes it's just a little trickle. When you think that your water's broken on it's own, look at the clock and see what time it is, check to see what color the fluid is (usually it's clear, sometimes it can be kinda brownish), and note if it smells funny (fishy, really bad, etc). There will be a test, 'cuz those are all answers to questions we're gonna ask you when come to the hospital...

R/O SROM - rule out spontaneous rupture of membranes. This is just a way of labeling the patients who call and say they're coming to the hospital. These patients usually say "I'm leaking" or "I felt a gush." There are different tests we can do to tell if your bag of water is broken or if it's something else. The best test is to let you sit on an absorbent pad while we ask you a bunch of questions and then check to see if there's a puddle under you in 10 or 15 minutes, but if that doesn't work, we usually do an amnisure test. This is simply a vaginal swab that we put in a solution and then stick in a test strip and if there's amniotic fluid then a mark will appear on the test strip. If there's still question afte this test, we can have a doctor do what's called a "ferning" test. This is another sterile vaginal swab that is done with a speculum and is put on a microscope slide. Amniotic fluid will make a 'ferning' pattern under the microscope. The other secret is that if it "swims" under the microscope, it's not amniotic fluid, it's something else...

ROL - rule out labor. Another label patients get before they come in. Usually they come in and say "I've been having contractions X minutes apart." We'll have you change into a gown, put you on the monitor and ask you a bazillion questions about when you started having contractions, how long they last, how often they happen, when you're due date is, who your doctor is, when you ate/drank last, what meds you take, what you're allergic to, if this is your first baby, etc. If you're termish (after 37 weeks) we'll usually check your cervix, let you walk, lay in bed, watch TV, etc, for an hour and then re-check your cervix. If you've changed, there's a good chance you're in labor. If you haven't really changed, well, then it's up to your doctor if you get to stay or not :)

PIH - pregnancy induced hypertension. I could do a blog just on this, 'cuz it can be a major complication of pregnancy, but just the quick and dirty version is: for some unknown reason some mom's can develop high blood pressure during pregnancy, and this can be dangerous because it restricts blood supply to the uterus and placenta and baby. If you go to the doctor and they take your blood pressure (usually sitting straight up and after walking into the office) and it's "higher than they would like" then they send you over to the hospital. We'll take you into the room, have you pee in a cup and calmly get into bed and roll to your left side. They we'll track down baby with the fetal monitor and then take your blood pressure after a few minutes. There's something magic about the left side (or any side really), but it rolls baby to the side and off the main blood vessels in your chest and abdomen, miraculously, most women's blood pressures are fine when they get to us :) Yea! We will also dip your urine to check for protein and depending on what your urine dips and what your blood pressure is we might draw labs and check different levels. PIH is just the beginning of more serious complications that can occur if it's not caught in the beginning. It's better to be safe than sorry...always!

Mec - meconium. This is the first bowel movement that your baby has. It's usually thick and black and tarry. Every baby has this at some point (hopefully soon after it's born!) When meconium can become a slight issue is when your cute little baby decides they just can't hold it anymore and poops before he or she comes out. This turns your normally clear amniotic fluid a brownish color. Whenever a doctor AROM's a patient we note the color of fluid that we see with the initial gush, and if your water breaks on it's own, we'll ask you what color fluid you saw. If we do see meconium in the fluid, there will probably be an extra baby person in the room at delivery. The thing we don't want to happen is for the baby to take a big deep breath when their head comes out and suck in a lung full of meconium fluid into their lungs. The doctor will usually take a second and suction out the baby's mouth and nose right after the head comes out before they delivery the shoulders and the rest of the baby. They might also stick a small suction catheter down the nose or mouth down into the lungs to suck out any meconium fluid that may have gotten down there. If meconium gets into the lungs it can cause an infection just like if anything gets into the lungs that isn't supposed to be there. The extra baby person really keeps a close eye on baby and the nursery nurses will also watch extra close just to make sure baby doesn't develop any breathing problems from the meconium in the first few hours. Most babies do just fine.

LEEP - Loop Electrosurgical Excision Procedure.I had to look up all the technicalities on this one myself to make sure that I explained it right. I just learned about it myself a couple weeks ago from my favorite nurse J :) A LEEP is (from the info I got and what I was told) is a type of cervical biopsy. A small wire loop is attached to an instrument (electrosurgical generator) and when scraped against your cervix during a pap smear slices off a small amount of cells that the doctor can send to the lab to have examined. Before the procedure your doctor should use some type of anesthetic to numb your cervix before he takes the cells off (but it STILL doesn't sound too comfortable to me...) and then he will probably use some anti-bleeding devices after the procedure and you should be able to go home within a few minutes after the procedure. Where a L&D nurse has any concern with a LEEP procedure is the fact that it causes scar tissue to form on the cervix from where the cells were removed. This may cause the cervix to have some problems with the cervix dilating during labor. Sometimes the cervix will dilate just a little bit and then seem to really get stuck and it may even take some manual dilatation to break the scar tissue (some people may prefer to have an epidural or some type of pain relief before this happens). After the scar tissue is broken, the cervix usually dilates normally. I believe that there is a similar procedure, LEAP, but I'm not sure what the exact difference is (something about how it's performed, maybe one uses a laser instead of a wire, I'm not 100% sure), but I do know that it gives the same results (scar tissue on the cervix).

So there's 10 new words/phrases to add to your daily vocabulary :) I'm sure I missed one or two, so ask if I spit something out you've never heard of. All you really good L&D nurses who have been doing this way longer than I have, if I explained something wrong or you have something to add that I forgot, tell me and I'll stick it in!

5 comments:

  1. Thank you! I've seen AROM/SROM a lot and kept meaning to look those up.

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  2. I am curious about LEEP from your previous post.

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  3. I'm adding LEEP paragraph right now...thanks for asking!

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  4. Thanks for the info; this was a great post. Do more of these please!!! I just learned a lot of new info..given to us straight up! I am not a nurse at all. I'm an average person who is in the beginning stages of TTC with husband, so I'm just taking it all in.

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  5. Hi there! It is so nice to meet you!! THank you for stopping by! I look forward to reading more about you and your L&D adventures! And thanks for the encouragement, I need it right now!

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